P70
Outcome of first-line tuberculosis treatment and clinical evolution of Mycobacterium africanum and Mycobacterium tuberculosis infected patients during three years post-treatment
B Diarra(1) M Kone(1) Y S Sarro(1) M Tolofoudie(1) A B Cissé(2) A Maiga(3) D B Fofana(1) A C G Togo(1) A M Somboro(1) B Baya(1) M Sanogo(1) O Kodio(1,4) M Maiga(1) K S Saliba(6) S Diallo(1) B C Dejong(7) S Doumbia(1)
1:University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali; 2:National reference Laboratory f Mycobacteriology, National Institute of Public Health (INSP), Ministry of Health and Social Affairs, Bamako, Mali; 3:medical Biology and Hospital hygiene Laboratory, University Teaching Hospital of Point-G, Bamako, Mali; 4:National Laboratory for Health, LNS, Ministry of Health and Social Affairs, Bamako, Mali; 5:Northwestern University, Chicago, Illinois, USA; 6:Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID)/National Institutes of Health (NIH), Bethesda, MD, United States; 7:Mycobacteriology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium.
First-line tuberculosis (TB) is treated for six months, which is successful in 95% of patients, provided they have good adherence, and in the absence of comorbidities and/or host tolerance and mycobacterial lineages. The goal of our study was to evaluate the outcome of first-line TB treatment and clinical evolution of patients infected with M. africanum and M.tuberculosis during three years post-treatment.
Between 2015 and 2021, we conducted a cohort study by enrolling new adult smear positive pulmonary TB patients in Bamako in an IRB approved protocol. After treatment completion, every six-month patients were called to assess their clinical evolution. Spoligotyping was used to determine mycobacterial lineages (L). Of 1,283 patients enrolled, 913 (71.2%) were male, and the age group of 25-34 years old was the most represented (34%). The prevalence of HIV coinfection was 7.4%. The most widely represented lineage was the modern L4, (57%), followed by L5/6 (M. africanum, 25%). In addition, 66.8%, and 16.5% had bacteriologically favorable and unfavorable outcome, respectively. BMI≤18.5 and HIV+ status were associated with the poor outcomes (aOR: 1.4, 95% CI 1.1 – 1.9; 2.9, 95% CI 1.8 – 4.8). Moreover, during the follow up, there was no difference between the rate of death in L4 and L5/6 infected patients.
The treatment success rate is below the 85% target of the DOTS strategy. HIV co-infection and low BMI were significantly associated with unfavorable outcome and should be monitored carefully. Whether human recovery is related to different mycobacterial lineages was not observed and may require longer period.